Question 1

A common criticism of HMOs, PPOs and other managed care organizations is that the sickest patients resist use of managed care because they are uncomfortable with the gatekeepers and managers involved in obtaining their health care.

Accepted Answer

A) True 
 B)False  True

Question 2

Explain why pharmacy benefits managers might be in favor of re-importation of prescription drugs from Canada to the U.S.

Accepted Answer

The role of the pharmacy benefits manage...

Question 3

The proportion of an insurance company's premium income spent on provision of treatments is called the

Accepted Answer

A)   formulary.
B)   capitation per member per month.
C)   point of service.
D)   medical loss ratio.
E)   total premium.F) B) and E)
G) A) and B)

Question 4

High deductible plans increase consumer awareness of costs of medical care by forcing them to pay for expenses up to a deductible amount. The negative aspect of this is that employees may not like having to spend extra time gathering information about price differences between providers.

Accepted Answer

A) True 
 B)False

Question 5

In 2012, U.S. spending on health care totaled almost 18% of GDP. Near term projections by the Congressional Budget Office (CBO) and the Centers for Medicare and Medicaid (CMS) of the growth rate of national health care expenditures estimate that health care expenses will escalate to almost 20% of GDP within 10 years. Why is this issue important to the federal government? (Be sure to include the idea of opportunity cost.)

Accepted Answer

If the escalation of healthcare costs co...

Question 6

The effect of either one of these two initiatives on consumers' welfare would be exactly the same.

Accepted Answer

A) True 
 B)False

Question 7

Medicaid is funded by a 1.45% tax on employers and a matching 1.45% tax on employees.

Accepted Answer

A) True 
 B)False

Question 8

Which of the following assertions about the uninsured is incorrect?

Accepted Answer

A)   Many of the uninsured cannot afford coverage.
B)   Many of the uninsured are young and healthy individuals, for whom not having insurance is a rational economic decision.
C)   Some of the uninsured are unable to obtain coverage because of a preexisting condition.
D)   The number of the uninsured in the U.S. exceeds 30% of the population.
E)   The percentage of the population without coverage depends significantly on the efforts of local and state governments.F) A) and C)
G) None of the above D

Question 9

Jayda receives a phone call from her doctor's office reminding her that it is time to bring her twelve year old son in for a wellness checkup. She is part of an HMO. How does one reconcile this unsolicited office visit with capitation, which has the goal of minimizing costs to HMOs.

Accepted Answer

Along with managing the tendency for ove...

Question 10

Which of the following statements about Medicare is false?

Accepted Answer

A)   Enrollment into Part A is automatic.
B)   Enrollment into Part B is optional, as it requires payment of an additional premium.
C)   Almost all Medicare enrollees (98 percent)  participate in both Parts A and B.
D)   88 percent of those with Medicare have supplemental insurance.
E)   Part A premiums are income-based.F) A) and B)
G) A) and D)

Question 11

A physician graduates from medical school and must decide whether to take a job as a junior member of a large group practice or work for an HMO directly. For the physician, a positive aspect of working for the HMO is

Accepted Answer

A)   lack of utilization controls.
B)   very little peer review.
C)   higher salary than with the group practice.
D)   a steady stream of patients and income.
E)   lower salary than with the group practice.F) B) and D)
G) A) and B)

Question 12

The public perception of either one of these two initiatives, and the willingness to vote for either initiative, would be exactly the same.

Accepted Answer

A) True 
 B)False

Question 13

Your grandmother is admitted to the hospital with a heart attack at 8:00 a.m. By time you arrive for a visit at 4:30 p.m., the social worker is looking for you to schedule a meeting to discuss where your grandmother will go when she leaves the hospital. This is an example of

Accepted Answer

A)   capitation.
B)   pre-certification.
C)   retrospective review.
D)   discharge planning.
E)   estate planning.F) C) and E)
G) A) and C)

Question 14

The size of private health insurance premiums depends on all of the following except

Accepted Answer

A)   prices.
B)   expected utilization volume.
C)   administrative costs.
D)   profit margin.
E)   number of carve-outs in a plan.F) A) and B)
G) A) and C)

Question 15

Managed care organizations

Accepted Answer

A)   compete with each other on quality and low cost provision of services.
B)   exclude health maintenance organizations.
C)   exclude preferred provider organizations.
D)   exclude closed-panel HMOs.
E)   are often run by the federal government.F) A) and B)
G) B) and D)

Question 16

If Medicare significantly lowers its reimbursement rates to physicians, discuss the likely consequences of this event for all parties.

Accepted Answer

For physicians, this would reduce their ...

Question 17

Requiring patients to have psychological exams, echocardiograms, mammograms, and blood tests before undergoing bariatric surgery (an elective surgery which induces weight loss)  is an example of

Accepted Answer

A)   pre-admission testing.
B)   capitation.
C)   retrospective review.
D)   discharge planning.
E)   second opinion.F) D) and E)
G) C) and E)

Question 18

When it comes to attempts of managed care to control costs, cutting prices is one of the most popular methods. Which of the following is not among the valid explanations of the rationale behind this practice?

Accepted Answer

A)   Price cuts would put money directly into the pocket of patients.
B)   Compared to other methods, prices are easier to cut.
C)   Large insurers have bargaining power to negotiate lower prices with providers.
D)   When certain markets go through periods of excess supply, large insurers use it to negotiate lower prices.
E)   Large insurers can threaten providers with taking the patients away unless discounts are provided.F) C) and D)
G) B) and C)

Question 19

Medicare is the most important health insurer in the U.S because it insures the most people, followed by employer sponsored private insurance, privately purchased health insurance, Medicaid and other federal insurance programs.

Accepted Answer

A) True 
 B)False  False

Question 20

All of the following are examples of substituting cheaper forms of care for more expensive ones, except

Accepted Answer

A)   prescribing a generic (vs. brand name)  medication.
B)   recommending chiropractic care instead of back surgery.
C)   authorizing outpatient vs. inpatient surgery.
D)   recommending nursing home care vs. hip replacement surgery.
E)   using a physician assistant (vs. doctor)  to see patients with uncomplicated health issues.F) A) and E)
G) B) and C)

Exam 5: Insurance Contracts and Managed Care

A common criticism of HMOs, PPOs and other managed care organizations is that the sickest patients resist use of managed care because they are uncomfortable with the gatekeepers and managers involved in obtaining their health care.

Correct Answer
verified
True

Explain why pharmacy benefits managers might be in favor of re-importation of prescription drugs from Canada to the U.S.

Correct Answer
verified
The role of the pharmacy benefits manage...
View Answer

The proportion of an insurance company's premium income spent on provision of treatments is called the

Correct Answer
verified

High deductible plans increase consumer awareness of costs of medical care by forcing them to pay for expenses up to a deductible amount. The negative aspect of this is that employees may not like having to spend extra time gathering information about price differences between providers.

Correct Answer
verified

Correct Answer
verified
If the escalation of healthcare costs co...
View Answer

The effect of either one of these two initiatives on consumers' welfare would be exactly the same.

Correct Answer
verified

Medicaid is funded by a 1.45% tax on employers and a matching 1.45% tax on employees.

Correct Answer
verified

Which of the following assertions about the uninsured is incorrect?

Correct Answer
verified
D

Jayda receives a phone call from her doctor's office reminding her that it is time to bring her twelve year old son in for a wellness checkup. She is part of an HMO. How does one reconcile this unsolicited office visit with capitation, which has the goal of minimizing costs to HMOs.

Correct Answer
verified
Along with managing the tendency for ove...
View Answer

Which of the following statements about Medicare is false?

Correct Answer
verified

A physician graduates from medical school and must decide whether to take a job as a junior member of a large group practice or work for an HMO directly. For the physician, a positive aspect of working for the HMO is

Correct Answer
verified

The public perception of either one of these two initiatives, and the willingness to vote for either initiative, would be exactly the same.

Correct Answer
verified

Your grandmother is admitted to the hospital with a heart attack at 8:00 a.m. By time you arrive for a visit at 4:30 p.m., the social worker is looking for you to schedule a meeting to discuss where your grandmother will go when she leaves the hospital. This is an example of

Correct Answer
verified

The size of private health insurance premiums depends on all of the following except

Correct Answer
verified

Managed care organizations

Correct Answer
verified

If Medicare significantly lowers its reimbursement rates to physicians, discuss the likely consequences of this event for all parties.

Correct Answer
verified
For physicians, this would reduce their ...
View Answer

Requiring patients to have psychological exams, echocardiograms, mammograms, and blood tests before undergoing bariatric surgery (an elective surgery which induces weight loss) is an example of

Correct Answer
verified

When it comes to attempts of managed care to control costs, cutting prices is one of the most popular methods. Which of the following is not among the valid explanations of the rationale behind this practice?

Correct Answer
verified

Medicare is the most important health insurer in the U.S because it insures the most people, followed by employer sponsored private insurance, privately purchased health insurance, Medicaid and other federal insurance programs.

Correct Answer
verified
False

All of the following are examples of substituting cheaper forms of care for more expensive ones, except

Correct Answer
verified

Exam 5: Insurance Contracts and Managed Care

A common criticism of HMOs, PPOs and other managed care organizations is that the sickest patients resist use of managed care because they are uncomfortable with the gatekeepers and managers involved in obtaining their health care.

Correct AnswerverifiedTrue

Explain why pharmacy benefits managers might be in favor of re-importation of prescription drugs from Canada to the U.S.

Correct AnswerverifiedThe role of the pharmacy benefits manage...View AnswerShow Answer

The proportion of an insurance company's premium income spent on provision of treatments is called the

Correct AnswerverifiedShow Answer

High deductible plans increase consumer awareness of costs of medical care by forcing them to pay for expenses up to a deductible amount. The negative aspect of this is that employees may not like having to spend extra time gathering information about price differences between providers.

Correct AnswerverifiedShow Answer

Correct AnswerverifiedIf the escalation of healthcare costs co...View AnswerShow Answer

The effect of either one of these two initiatives on consumers' welfare would be exactly the same.

Correct AnswerverifiedShow Answer

Medicaid is funded by a 1.45% tax on employers and a matching 1.45% tax on employees.

Correct AnswerverifiedShow Answer

Which of the following assertions about the uninsured is incorrect?

Correct AnswerverifiedD

Jayda receives a phone call from her doctor's office reminding her that it is time to bring her twelve year old son in for a wellness checkup. She is part of an HMO. How does one reconcile this unsolicited office visit with capitation, which has the goal of minimizing costs to HMOs.

Correct AnswerverifiedAlong with managing the tendency for ove...View AnswerShow Answer

Which of the following statements about Medicare is false?

Correct AnswerverifiedShow Answer

A physician graduates from medical school and must decide whether to take a job as a junior member of a large group practice or work for an HMO directly. For the physician, a positive aspect of working for the HMO is

Correct AnswerverifiedShow Answer

The public perception of either one of these two initiatives, and the willingness to vote for either initiative, would be exactly the same.

Correct AnswerverifiedShow Answer

Your grandmother is admitted to the hospital with a heart attack at 8:00 a.m. By time you arrive for a visit at 4:30 p.m., the social worker is looking for you to schedule a meeting to discuss where your grandmother will go when she leaves the hospital. This is an example of

Correct AnswerverifiedShow Answer

The size of private health insurance premiums depends on all of the following except

Correct AnswerverifiedShow Answer

Managed care organizations

Correct AnswerverifiedShow Answer

If Medicare significantly lowers its reimbursement rates to physicians, discuss the likely consequences of this event for all parties.

Correct AnswerverifiedFor physicians, this would reduce their ...View AnswerShow Answer

Requiring patients to have psychological exams, echocardiograms, mammograms, and blood tests before undergoing bariatric surgery (an elective surgery which induces weight loss) is an example of

Correct AnswerverifiedShow Answer

When it comes to attempts of managed care to control costs, cutting prices is one of the most popular methods. Which of the following is not among the valid explanations of the rationale behind this practice?

Correct AnswerverifiedShow Answer

Medicare is the most important health insurer in the U.S because it insures the most people, followed by employer sponsored private insurance, privately purchased health insurance, Medicaid and other federal insurance programs.

Correct AnswerverifiedFalse

All of the following are examples of substituting cheaper forms of care for more expensive ones, except

Correct AnswerverifiedShow Answer

Correct Answer
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True

Correct Answer
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The role of the pharmacy benefits manage...
View Answer

Correct Answer
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Correct Answer
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Correct Answer
verified
If the escalation of healthcare costs co...
View Answer

Correct Answer
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Correct Answer
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Correct Answer
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D

Correct Answer
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Along with managing the tendency for ove...
View Answer

Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
verified

Correct Answer
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Correct Answer
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Correct Answer
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For physicians, this would reduce their ...
View Answer

Correct Answer
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Correct Answer
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Correct Answer
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False

Correct Answer
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