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Private health insurance coverage has decreased over the past decades because of.

A.
The rising cost of health care.
A.
The rising cost of health care.
Answers
B.
An increase in non-unionized jobs
B.
An increase in non-unionized jobs
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C.
A shift from manufacturing jobs to service industry jobs
C.
A shift from manufacturing jobs to service industry jobs
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D.
All of the above
D.
All of the above
Answers
Suggested answer: D

Patient cost sharing (deductibles and copayments) reduces the rate of ambulatory care use, especially among the.

A.
Uninsured
A.
Uninsured
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B.
Critically ill
B.
Critically ill
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C.
Poor
C.
Poor
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D.
All of the above
D.
All of the above
Answers
Suggested answer: C

All of these factors impact the health status of an individual, however, the one exerting the least influence is.

A.
Medical care
A.
Medical care
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B.
Educational level
B.
Educational level
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C.
Income level
C.
Income level
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D.
Broad socioeconomic factors
D.
Broad socioeconomic factors
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Suggested answer: A

The major form(s) of managed care organizations are:

A.
Fee-for-service with utilization review
A.
Fee-for-service with utilization review
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B.
Preferred provide organizations (PPOs)
B.
Preferred provide organizations (PPOs)
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C.
Health maintenance organizations (HMOs)
C.
Health maintenance organizations (HMOs)
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D.
All of the above.
D.
All of the above.
Answers
Suggested answer: D

The form of payment that is based specifically on the individual components of health care is.

A.
Fee-for-service reimbursement.
A.
Fee-for-service reimbursement.
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B.
Per Diem payment.
B.
Per Diem payment.
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C.
Reimbursement by episode of illness.
C.
Reimbursement by episode of illness.
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D.
Capitation payment.
D.
Capitation payment.
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Suggested answer: A

Surgeons usually receive a single payment for the surgery and postoperative care. This bundling, or payment per episode, gives surgeons an economic incentive to.

A.
Limit both the number of surgeries they perform and the number of post operative visits they make.
A.
Limit both the number of surgeries they perform and the number of post operative visits they make.
Answers
B.
Increase both the number of surgeries and the number of post operative visits.
B.
Increase both the number of surgeries and the number of post operative visits.
Answers
C.
Limit the number of surgeries and increase the number of post operative visits.
C.
Limit the number of surgeries and increase the number of post operative visits.
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D.
Increase the number of surgeries and limit the number of post operative visits.
D.
Increase the number of surgeries and limit the number of post operative visits.
Answers
Suggested answer: D

Which of the following best describes the incentives associated with capitation?

A.
Physicians have a higher incentive to sign up only healthy patients.
A.
Physicians have a higher incentive to sign up only healthy patients.
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B.
Physicians have more flexibility to deliver effective and efficient services to patients.
B.
Physicians have more flexibility to deliver effective and efficient services to patients.
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C.
It only pays for an in-person visit with a physician.
C.
It only pays for an in-person visit with a physician.
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D.
A and B only
D.
A and B only
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Suggested answer: D

Diagnosis-Related Groups (DRGs) lumps together all services performed during a hospital episode.

Under the DRG system, which is/are true?

A.
Medicare is at risk for the number of admissions.
A.
Medicare is at risk for the number of admissions.
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B.
The hospital is at risk for the number of admissions.
B.
The hospital is at risk for the number of admissions.
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C.
The hospital is at risk for the length of stay.
C.
The hospital is at risk for the length of stay.
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D.
Only A and C
D.
Only A and C
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Suggested answer: D

The management of a rare and complex disorder such as pituitary tumors would be considered an example of.

A.
Primary care
A.
Primary care
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B.
Secondary care
B.
Secondary care
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C.
Tertiary care
C.
Tertiary care
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D.
Both A and B
D.
Both A and B
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Suggested answer: C

A generalist care coordinator can advocate on behalf of his/her patients to integrate services from multiple providers. Besides caring for the whole person, an advantage(s) of care coordination include:

A.
Enhancing patient safety
A.
Enhancing patient safety
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B.
Avoiding the duplication of services
B.
Avoiding the duplication of services
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C.
Prohibiting the use of all specialist services
C.
Prohibiting the use of all specialist services
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D.
A and B only
D.
A and B only
Answers
Suggested answer: D
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