HAS 3430 Mid-term exam,100% CORRECT

1. In colonial America, the primary mode of medical education was: A. student apprenticeship with European trained physicians B. applied folklore using herbal remedies C. on-the-job experience in one of the few exist ...

1. In colonial America, the primary mode of medical education was: A. student apprenticeship with European trained physicians B. applied folklore using herbal remedies C. on-the-job experience in one of the few existing hospitals D. All of the above 2. Medical societies were first established for the primary purpose of: A. overseeing the construction of new medical schools B. promoting medical school affiliations with hospitals C. improving the quality of medical education and practice D. establishing national standards for granting the MD degree E. help increase the income for physicians 3. In 1905, the American Medical Association, with support from the Carnegie Foundation, commissioned a study of U.S. medical schools in response to decades of concern about the quality of medical education and training. The resulting Flexner Report is considered a benchmark in the history of medical education because it: A. resulted in some schools making changes that improved the quality of their programs B. stimulated licensing legislation and established new requirements pertaining to training lengths and quality standards in laboratories and other training facilities C. resulted in the closure of all medical schools that did not meet quality criteria D. resulted in contributions of large sums of charitable dollars from foundations and wealthy individuals 4. In 1965, the federal government recognized the contributions of medical-school/teaching-hospital research and training activities in advancing the sophistication and effectiveness of medical care with the passage of: A. Regional Medical Program legislation B. Medicare and Medicaid legislation C. The Health Systems Agency legislation D. The Health Professions Education Assistance Act 5. Academic Health Centers may be best described as: A. complexes of medical schools and teaching hospitals on the same campus B. major research facilities that are affiliated with a teaching hospital and a medical school C. complexes of medical schools and other health professional schools -- such as nursing, pharmacy, dentistry, and allied health -- affiliated with each other and with teaching hospitals and other research and clinical facilities D. major hospitals that attract complex medical cases that provide valuable teaching experience for medical students 6. Specialization in medical training, while resulting in high-quality care, also caused significant problems for the medical care delivery system. Such problems include: A. lower costs and fragmentation of patient care continuity B. the tendency of specialists to concentrate practices in urban centers, leaving large geographic areas underserved C. an undersupply of generalist physicians 7. In 1991, the Pew Charitable Trusts issued a report on the future of medicine. In this report they said: (pg 167) A. medicine will focus on prevention B. health concerns will be addressed at a community level C. physicians will need to be versed in social and environmental health determinates D. all of the above 8. Which state, in 1821, was the first to restrict medical licenses to graduates of a medical school? A. New York B. Georgia C. Pennsylvania D. Maryland E. Massachusetts 9. What school was described as a "model for medical education." A. Yale B. Harvard C. McGill D. Johns Hopkins E. Dartmouth 10. Hospitals associate with academic health centers are more expensive than regular hospitals. How much more expensive are they? A. 5 to 8 percent B. 10 to 16 percent C. 20 to 30 percent D. 35 to 42 percent E. 45 to 50 percent 11. The specialties of family medicine, internal medicine, and pediatrics all have the same sub-specialty. Which of the below is the common sub-specialty? A. Sports medicine B. Orthopedic medicine C. Cardiology D. Neurology 12. States try to protect the public from receiving incompetent care by licensing certain health professions. Certification differs from licensing, in that certification: A. only recognizes special education or training B. does not assure continuing competency C. may not examine the important competencies D. allows people to engage in activities that would otherwise be illegal 13. At the outset of the nurse practitioner movement, educational requirements were often limited to relatively short certificate programs. Today, it is generally accepted that nurse practitioners should be registered nurses with: A. an associate’s degree B. a hospital certificate of nursing competency C. a master’s degree D. a doctoral degree 14. Complementary medicine differs from alternative medicine in that complementary medicine: A. is used together with conventional medical treatment while alternative medicine is used in place of conventional medical treatment B. is limited to treatment by certified providers C. uses only organic substances in treatment D. is licensed by the Food and Drug Administration 15. The health care industry in the United States is a major employer. The proportion of the US workforce employed in health care is about: A. 5% B. 10% C. 15% D. 20% 16. A physician residency training program is best described as: A. a program enabling medical school graduates to become familiar with a population’s needs in a specific geographic area B. a training program that prepares physicians to practice in a medical specialty C. specialized training in the business operations of a medical practice D. the first opportunity for medical students to have actual contact with patients 17. Major obstacles to ensuring an efficient and rational health workforce in the future include: A. An inadequate number of educational institutions to accommodate qualified students B. An influx of foreign-trained graduates that exceeds demand C. Separate and often conflicting interests of governments, educational institutions, professional organizations, insurers and providers D. Declining need for health care professionals in several categories of practice 18. According to the Department of Labor, approximately _____ million people are working in health care currently, and in the next decade approximately _____ million new jobs will be created. A. 15.4 and 5 B. 13.8 and 4 C. 17.2 and 7 D. 10.9 and 2 E. 22.7 and 9 19. The number of women that are enrolled in U.S. medical schools has ____ over the last 20 years and the number of minorities has ____ over the same period. A. Doubled, tripled B. Stayed the same, declined by 5% C. Decreased by 50%, increased by 25% D. Tripled, doubled E. Decreased by 25%, increased by 10% 20. Nursing has changed over the years as a result of economic changes, and now includes non-nursing duties like supervising nonprofessionals and unlicensed personal performing nursing duties. This has caused which of the following? A. Increased nursing workloads B. Lower morale C. Raised concerns about the declining quality of care D. All of the above 21. Changes in the attitudes toward dentist in America were changed when the first two million draftees showed up for their physical 1 in 5 did not have the required 12 functional teeth needed to serve. In war did this occur? A. Korean War B. Vietnam Ware C. Civil War D. WW I E. WW II 22. Allied health personal represents a varied and complex array of health care disciplines. Which one of the list below is NOT an allied health discipline? A. Radiology technologist B. Physical therapist C. Clinical nurse specialist D. Physician’s assistant E. Social worker 23. Major influences on the evolution of the U.S. health care financing system have included: A. political and consumer concerns over the costs of care relative to its quality B. European models of economical health care services C. the physician lobby D. a combination of employer, consumer, purchaser and provider interests 24. The most recent trends in health care expenditure growth may be characterized as: A. rapidly increasing B. showing the slowest rate of growth in almost five decades C. far outstripping growth in the Gross Domestic Product D. responding to new managed care market forces 25. In comparison with 28 other Organization for Economic Cooperation and Development Countries, the U.S. A. has the best health outcomes B. spends much more, but has poorer health outcomes than many other countries C. has one of the highest rates of health insurance coverage for its citizens D. has higher rates of hospital and physician use than many other countries 26. Historically, factors contributing to growth in health care spending have included: A. additions of advanced technology B. specialized medicine C. reimbursement incentives D. all of the above E. none of the above 27. Uninsured or underinsured Americans have contributed to the high cost of health care because they: A. demand the best care when a need arises B. tend to postpone care until very ill C. tend to use hospital emergency services as their primary source of care 28. The fee-for-service system of reimbursement fueled high costs because it: A. encouraged physicians and hospitals to use the maximum number of services B. placed few, if any, restrictions on patients’ choice of services C. placed a strong emphasis on the quality of care D. all of the above 29. The managed care concept called “capitation” refers to: A. physicians agreeing to provide all medical care an individual requires for a specified time period, for a prepaid fee B. establishing a global budget with “caps” on expenditures C. establishing minimum quality performance standards D. purchasers of health care negotiating as a group 30. By focusing on insured populations rather than individuals, managed care organizations can project health service use by: A. previous patient histories B. demographic factors such as age, gender, and other factors C. national averages D. ratios of specialists to primary care providers 31. An aim of managed care is to transfer some measure of financial risk to providers and, to a lesser extent, to patients. Transferring financial risk to patients is accomplished by: A. requiring the use of clinical pathways B. using fee withholds C. monitoring provider practice patterns D. requiring co-pays for specified services 32. The arrangement in which some managed care organizations pay on a fee-for-service basis but penalize providers if they exceed preset service targets is called: A. capitation B. gatekeeping C. a withhold plan D. a staff model 33. Cost-control initiatives undertaken by managed care organizations to improve communications with chronic disease patients in the hope of avoiding unnecessary, costly care are known by the term: A. disease management B. acute episode avoidance C. emergency room deferral D. case management 34. The phenomenon of managed care “backlash” is best characterized by which of the following: A. a consumer protest against increasing health care insurance premiums B. protests of organized medicine, other health care providers and consumers against MCO policies viewed as unduly restrictive C. consumer concerns about high prescription drug costs D. numerous managed care company mergers 35. Medicaid can used for all of the following people EXCEPT: A. Low income family with children B. Long-term care for older Americans C. Supplemental coverage for low-income Medicare beneficiaries D. Low-income Medicare beneficiaries that have supplemental insurance 36. The Balanced Budget Act of 1997 may be best characterized as: A. a consumer reaction to Clinton’s failed National Health Security Act B. an attempt to address rising physician Medicare reimbursement C. enacting sweeping reductions in Medicare and Medicaid spending, opening the Medicare program to private insurers and opening access to millions of Medicaid-eligible children D. B and C E. none of the above 37. According to the 2008 statistics what was the total health care expenditure in America? A. $825 billion B. $943 billion C. $1.06 trillion D. $1.97 trillion E. $2.33 trillion 38. From 1999 to 2009 premiums for health care coverage for a family increased by? A. 50% B. 93% C. 131% D. 175% E. 216% 39. What group was against putting in national health coverage in the Social Security Act of 1935? A. AMA B. Managed care organizations C. AARP D. CDC E. None of the above 40. Which is the below is/are drivers of health care expenditures? A. Advancing medical and diagnostic technology B. Growth of older population C. Specialized medicine D. Under or uninsured E. All of the above 41. When Medicare was first implemented there were two parts. Over the years two more parts were added. Which part allows for private health plans to administer Medicare contracts? A. Part A B. Part B C. Part C D. Part D Definitions worth 1 point each 1. Flexner Report (page 153) The Flexner report on Medical Education in the United States and Canada was published by the Carnegie Foundation in 1910. It was a searing description of abuses in the medical schools. Assets and liabilities of each school were described in detail and corrective measures were offered. Schools were referred to as “disgrace” and a “plaque spot.” Schools that received praise for excellent performance included Harvard, Western Reserve, McGill, Toronto, and especially Johns Hopkins, which was described as a “model for medical education.” Flexnor's report gave increased leverage to medical reformers and stimulated support for medical education from foundations and wealthy individuals. 2. Residency program (page 157, 158, 159) To provide direct patient care, physicians are required to complete a 3- to 7- year graduate medical program accredited by the Accreditation Council for Graduate Medical Education (ACGME) in one of the recognized medical specialties. There are nearly 7,000 residency programs, loosely held together by accreditation and certification processes, medical schools, program directors, and hospital executives. 3. International medical school graduates (IMGs) (page 165) Most hospitals in the United States depend on IMGs to fill their residency positions. About one-fourth of all hospital residencies are filled by IMGs, and consequently they represent approximately one-fourth of the physician workforce in the United States. In 1998 a requirement was initiated that IMGs must pass a clinical skill assessment before entering a residency. This has created a significant drop in IMG entrants and as a result the quality of the applicants has improved while still providing enough IMGs to fill the residency positions not taken by US medical graduates. 4. Residency program 5. Allopathic medical schools 6. Alternative therapies Alternative medicine is used in place of conventional medicine. Naturopathic doctors do not have medical degrees but are trained in loosely monitored schools. Medical societies strongly oppose naturopathy and consider the practice “unscientific” and “irrational. In 1998, more than 40% of Americans reported the use of alternative or complementary therapies. Insurance companies have agreed to cover an alternative form of therapy such as acupuncture for a condition such as chronic pain when traditional medicine is ineffective and it satisfies the patient. Several states now require insurance companies to cover naturopathic procedures and others, such as acupuncture. 7. Mal-distribution of health care manpower (pg 214) 8. Retrospective reimbursement Retrospective reimbursement, in healthcare, is where reimbursement came after medical care was delivered. 9. Self-funded insurance program Employers collect the premiums themselves and put them into a fund so that it can pay claims for medical benefits instead of using another commercial carrier 10. Capitation A form a prepayment that gives providers for services on a basis of per-member-per-month 11. National Committee on Quality Assurance (NCQA) An organization that gives accreditations to health care facilities and produces publications that measures a facility's quality. Essay Questions For each essay question, you will write a 1 to 2 page reply to the question. The reply can be longer, but it cannot be less. The reply must be detailed and relevant to the question. Use information from the book, power points, and any other source you need. If you use a source to support your reply, you must cite your source using APA format. You must use proper grammar and spelling in the reply. You will be graded on how detailed you reply is and the relevance of your reply. 1) Academic medical centers were formed by the union of medical schools through affiliations with hospitals that provided clinical experience for medical students. These affiliations were later broadened into academic health centers. Describe the components of the academic health centers and their significance to the evolution of the university-based health professional education complex. They have expanded from the relationship between hospitals and universities to include nursing schools, pharmacy, dentistry, and allied health. Consequently, they became a powerful force. Academic health centers have become the principal places of education and training for physicians and other health care personnel, the sites for most basic research in medicine, and the clinical settings in which many of the advances in diagnosis and treatment are tested and perfected. 2) The various kinds of health professionals are educated in separate schools but with considerable overlap in curricula and training requirements. They are, however, expected to integrate their training and work together after graduation. Identify the advantages and disadvantages of this approach to professional education in terms of costs, educational efficiency, and patient care quality. 3) In what two ways have each of the following affected the costs of health care in the US?  The health insurance industry  Advances in medical care technology  Changes in U.S. demographics  Government support for health care  Consumer expectations