Question 1

Cost is shifted from people in poor health to the healthy when

Accepted Answer

A)  premiums are based on experience rating
B)  people purchase individual private health insurance policies instead of group policies
C)  first-dollar coverage is predominant
D)  premiums are based on community ratingE) All of the above
F) A) and B)

Question 2

A health insurance plan pays for medical care only after the insured has first paid $1,000 out of pocket on an annual basis.The $1,000 annual cost is called

Accepted Answer

A)  first-dollar coverage
B)  coinsurance
C)  premium
D)  deductibleE) All of the above
F) B) and C)

Question 3

When a fixed monthly fee per enrollee is paid to a provider, it is called

Accepted Answer

A)  Bundled fee
B)  Charge
C)  Capitation
D)  Retrospective reimbursementE) None of the above
F) B) and D)

Question 4

Long-term care services for the elderly are covered under Medicare.

Accepted Answer

A) True 
 B)False

Question 5

According to a US Supreme Court decision, individual states can decide whether or not to expand their Medicaid programs to comply with the ACA.

Accepted Answer

A) True 
 B)False

Question 6

Under the ACA, private health insurance will no longer be the main source of coverage.

Accepted Answer

A) True 
 B)False

Question 7

Under the Medicaid program, eligibility criteria and benefits are consistent throughout the US.

Accepted Answer

A) True 
 B)False

Question 8

Tax policy in the U.S.provides an incentive to obtain employer-paid health insurance.

Accepted Answer

A) True 
 B)False

Question 9

Capitation removes the incentive to

Accepted Answer

A)  control costs.
B)  provide unnecessary services.
C)  file a reimbursement claim.
D)  underutilize health care.E) None of the above
F) B) and C)

Question 10

Today, the majority of health insurance exists in the form of managed care plans.

Accepted Answer

A) True 
 B)False

Question 11

In national health care systems, total expenditures are controlled mainly through

Accepted Answer

A)  cost shifting
B)  underwriting
C)  supply-side rationing
D)  demand-side rationingE) B) and C)
F) None of the above

Question 12

Under experience rating,

Accepted Answer

A)  costs shift from people in poor health to people in good health
B)  favorable risk groups pay a lower premium than high-risk groups
C)  premiums rise for every one regardless of risk
D)  deductibles and copayments are eliminatedE) A) and B)
F) A) and C)

Question 13

Health insurance increases the demand for health care services.

Accepted Answer

A) True 
 B)False

Question 14

A copayment is generally paid

Accepted Answer

A)  once a year
B)  each time the insured receives health care services
C)  in form of a deduction from payroll checks
D)  by the employer to purchase health insurance on behalf of each covered employeeE) A) and C)
F) A) and B)

Question 15

What perverse incentive is present in retrospective reimbursement?

Accepted Answer

A)  Providers can increase their profits by increasing costs.
B)  Providers reduce their profits if they increase costs.
C)  Serving more patients would reduce profits.
D)  It leads to underutilization of health care services.E) None of the above
F) A) and B)

Question 16

What was the main conclusion of the Rand Health Insurance Experiment

Accepted Answer

A)  Cost sharing lowered health care utilization without any significant health consequences
B)  Cost sharing lowered health care utilization but there were significant health consequences
C)  Cost sharing did not affect health care utilization
D)  Cost sharing increased health care utilizationE) All of the above
F) None of the above

Question 17

The phenomenon called 'moral hazard' results directly from

Accepted Answer

A)  the uninsured status of a segment of the U.S.population
B)  inadequate payment to providers
C)  managed care enrollment
D)  health insurance coverageE) A) and C)
F) B) and D)

Question 18

By law, federal matching funds to the states for Medicaid cannot be less than

Accepted Answer

A)  25%
B)  33%
C)  50%
D)  80%E) None of the above
F) A) and C)

Question 19

For hospitalizations, Medicare beneficiaries must pay a deductible

Accepted Answer

A)  each time they are admitted to a hospital
B)  once per benefit period
C)  on discharge from a hospital
D)  None of the aboveE) None of the above
F) A) and C)

Question 20

An MS-DRG is a refined DRG that includes

Accepted Answer

A)  patient severity
B)  costs incurred in treating a patient
C)  adjustment for treating patients on Medicaid
D)  adjustment for readmissions within 30 days of dischargeE) A) and B)
F) A) and C)

Exam 6: Health Services Financing

An MS-DRG is a refined DRG that includes

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Today, the majority of health insurance exists in the form of managed care plans.

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When a fixed monthly fee per enrollee is paid to a provider, it is called

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For hospitalizations, Medicare beneficiaries must pay a deductible

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Under the ACA, private health insurance will no longer be the main source of coverage.

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Long-term care services for the elderly are covered under Medicare.

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A copayment is generally paid

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A health insurance plan pays for medical care only after the insured has first paid $1,000 out of pocket on an annual basis.The $1,000 annual cost is called

Correct AnswerverifiedShow Answer

Cost is shifted from people in poor health to the healthy when

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The phenomenon called 'moral hazard' results directly from

Correct AnswerverifiedShow Answer

Health insurance increases the demand for health care services.

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By law, federal matching funds to the states for Medicaid cannot be less than

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Tax policy in the U.S.provides an incentive to obtain employer-paid health insurance.

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What perverse incentive is present in retrospective reimbursement?

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What was the main conclusion of the Rand Health Insurance Experiment

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Capitation removes the incentive to

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In national health care systems, total expenditures are controlled mainly through

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According to a US Supreme Court decision, individual states can decide whether or not to expand their Medicaid programs to comply with the ACA.

Correct AnswerverifiedShow Answer

Under experience rating,

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Under the Medicaid program, eligibility criteria and benefits are consistent throughout the US.

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